Hello Veronica and Joan: Veronica, I was offended by your comments... I realized that I didn't make it know that I was seeing the client. There is not a PT involved!
Joan, you make very good points. I JUST ordered the LACLS, something that I've been meaning to do for some time!! Sad to say, it never occurred to me that her cognition might keep from form conceptualizing about occupational deficits. Man, I must be in a rut!! Ron ===========> Original Message Follows .... On5/5/2005, Joan Riches, <[EMAIL PROTECTED]> said: JR> Hi Ron JR> Of course I agree with Elizabeth's suggestion that you look at cognition JR> with the Allen Cognitive Levels. I guess this is the time to keep my promise JR> to talk about that model. JR> Your difficulty is that "she doesn't identify any occupational goals". With JR> declining cognition one of the first effects is loss of the ability to JR> predict the possible implications of one's actions. These are people who JR> seem just fine - still remembering things - good communication - often JR> pleasant and cooperative - still able to explain proverbs or perhaps a bit JR> concrete. With a difficulty they look for obvious causes ie balance in the JR> case of a fall and want to remediate it. They will know they don't want to JR> fall again however they are likely to be unable or find it very difficult to JR> speculate about the effect on their valued occupation(s) if they do fall JR> (Allen Cognitive Level 5). JR> Identifying an occupational goal is a very sophisticated cognitive activity JR> - think how OT students struggle to develop that point of view. JR> I think you would find these sites interesting JR> http://www.allencogadvisor.com/ and JR> http://www.ot-innovations.com/home.html. JR> The new Allen Cognitive Network site will be up soon and I'll post it to the JR> list as soon as it is available. JR> Joan Riches JR> -----Original Message----- JR> From: [EMAIL PROTECTED] JR> [mailto:[EMAIL PROTECTED] On Behalf JR> Of Veronica JR> Sent: Thursday, May 05, 2005 7:22 AM JR> To: [email protected] JR> Subject: Re:[OTlist] What to do? JR> Hi Ron, JR> Didn't mean to cause offence (if I did, apologies!). I did realise that you JR> were seeing the lady from your email, but was wondering if PT was also JR> involved to address purely mobility issues. JR> And I agree that from a philosophical point of view it raises a can of JR> worms! We so often see clients that have 'mobility' difficulties and their JR> main goal is to 'walk'. They don't understand the other factors that need JR> to be addressed at the same time. JR> Similar factors affect the therapy input that we provide for kids (only JR> there you also have the parents and teachers adding their concerns). With JR> kids we end up asking: 'who is the client?' and 'who's goals do you treat?' JR> is it the parent or the teacher who's goals take precedence, or do we listen JR> to what the children say and focus on their desires... I could add my JR> opinion (and the opinion of a number of other OT's that I've spoken to), JR> where the child is our primary client and the one who's wishes should be JR> considered. The problem arises when you have mom who wants little Johnny to JR> write neatly and the teachers who want little Johnny to sit still in class JR> and pay attention. All legitimate concerns but not something that JR> particularly bothers little Johnny and not something that he is particularly JR> keen on or motivated to do!!! JR> Veronica JR> PS in answer to the question 'should you be seeing her' my answer is: what JR> would happen if you DIDN'T see her? JR> Ron Carson <[EMAIL PROTECTED]> wrote: JR> Hello Veronica: JR> I am seeing the patient! However, I am struggling to understand if I JR> should be seeing the patient because she doesn't identify any JR> occupational goals. I used to tell students, if there no occupational JR> goals identified, then there's no role for OT. The goals with the client JR> are mobility related like: "Client will safely ambulate to bathroom JR> using appropriate mobility aid". I am comfortable with the goal IF the JR> client identified the deficit. But she didn't, I did! I know that in JR> some cases, clients are cognitively unable to identify goals, but such JR> is not the case with this client. JR> What I am asking is more of a philosophical rather than practical JR> question. Of course, the client needs therapy and of course, OT can JR> treat the client but based on our treatment philosophy of being JR> client-centered and addressing occupation, my question is SHOULD I be JR> seeing her? JR> Ron JR> --------------------------------- JR> How much free photo storage do you get? Store your holiday snaps for FREE JR> with Yahoo! Photos. Get Yahoo! Photos -- Unsubscribe? [EMAIL PROTECTED] Change options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] Help? [EMAIL PROTECTED]
